Illinois State University
Mennonite College of Nursing
Doctor of Nursing Practice Student Annual Evaluation
Date: Click here to enter a date. Student Name: Click here to enter text. UID#: Click here to enter text.
Benchmarks by Essential
Student self-evaluation
- Check components completed
- Comment on plan to complete remaining components in the next year
Essential I: Scientific Underpinnings for Practice
☐NUR 564 Evidence-Based Practice
☐NUR 562 Leadership in Health Care Systems
☐NUR 543 Scholarly Project I (proposal)
☐Scholarly Project poster presentation
Essential II: Org. and Systems Leadership for Quality Improvement and Systems Thinking
☐NUR 562 Leadership in Health Care Systems
☐NUR 565 Changing Health Care Systems
☐NUR 451/569 Financial and Resource
Management
☐Scholarly Project Committee Appointment (form)
☐NUR 545 Scholarly Project II (implementation)
☐Scholarly Project podium presentations
(committee, college, stakeholder)
Essential III: Clinical Scholarship and Analytical Methods for Evidence-Based Practice
☐NUR 535 Applied Data Management and Analysis
☐NUR 564 Evidence-Based Practice
☐NUR 451/569 Financial and Resource
Management
☐NUR 545 Scholarly Project III (evaluation)
☐Scholarly Project manuscript (submitted to
professional journal and deposited at ISU ReD)
Essential IV: Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care
☐NUR 509 Introduction to Nursing Informatics
☐NUR 535 Applied Data Management and Analysis
Essential V: Health Care Policy for Advocacy in Health
Care
☐NUR 511 Health Policy
☐NUR 562 Leadership in Health Care Systems
Essential VI: Interprofessional Collaboration for Improving Patient and Population Health Outcomes
☐NUR 565 Changing Health Care Systems
☐NUR 451/569 Financial and Resource
Management
☐Authorship Agreement (form)
Essential VII: Clinical Prevention and Population Health for Improving the Nation’s Health
☐NUR 564 Evidence-Based Practice
☐NUR 565 Changing Health Care Systems
☐NUR 511 Health Policy
Essential VIII: Advanced Practice Nursing
☐640 practice hours
☐Declaration of Residency (form)
☐NUR 550 Practice Residency I
☐NUR 552 Practice Residency II
☐NUR 554 Practice Residency III
☐DNP Professional Portfolio
Comments:Click here to enter text.
Faculty Advisor Evaluation and Recommendation
(To be completed by faculty advisor)
Date: Click here to enter a date.
Student Name: Click here to enter text.
This is to verify that an Annual Evaluation has been conducted for the above student including review of grades, scholarly productivity, adherence to plan of study and progress toward scholarly project completion.
The following action is recommended: (check only one)
☐1. Satisfactory progress (original plan of study is current, attach a copy)
☐2. Satisfactory progress, however, a revised plan of study is required.
(Attach a copy of revised program of study.)
☐3. Unsatisfactory progress – a revised plan of study and/or other
requirements are listed below.
Faculty Advisor Comments or Requirements:
Click here to enter text.
Approved:
Student Signature______Date Click here to enter a date.
Faculty Advisor Signature ______Date Click here to enter a date.
DNP Program Leader Signature ______Date Click here to enter a date.
Director of Graduate Programs Signature ______Date Click here to enter a date.
Forward this form and a current plan of study to
MCN Office of Student Services